Provider Demographics
NPI:1356483218
Name:DUNKWU, FELIX N (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FELIX
Middle Name:N
Last Name:DUNKWU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-1981
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:3661 S BABCOCK ST FL 2
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-8205
Practice Address - Country:US
Practice Address - Phone:321-434-7611
Practice Address - Fax:321-727-3738
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106921363A00000X
CAPA17946363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHB150ZOtherMEDICARE
FL009708200Medicaid